Breathlessness | Nursing | Case Study

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The following assignment is based on the case study of Russell who is a truck driver.
Russell is 68 years old. He was admitted to the Monash Health with symptoms of
breathlessness. Doctor’s investigation revealed that Russell has developed heart failure.
Russell has previous reported cases of heart attack and COPD and he was an active smoker.
This assignment is questions and answers based assignment. The initiation of the assignment
will be done based on the reasons underlying Russell’s heart failure. This will be followed by
detailed description of the exacerbations of COPD followed by the mode of actions of certain
medications and nursing interventions (non-pharmacological) in order to manage the nursing
priority.
Risk factors contributed to disease development
Russell had encountered heart failure 15-years ago and the same was treated with
stent. Fatima, Naqvi and Hanook (2019) older adults who are above 60 years of age and have
previous reported cases of cardiovascular stroke are more vulnerable to develop heart failure.
The presence of reported cases of Chronic Obstructive Pulmonary Disease (COPD) further
increases the overall risk factors of heart failure. Russell had COPD for the past 30 years and
had smoking habits. Bayrak and Tosun (2018) stated that presence of COPD, for a prolong
tenure of time decrease the overall oxygen carrying capacity of the lungs and thereby
decreasing the overall oxygen content of blood. In the absence of adequate oxygen in the
heart, the cardiac muscles are being forced to pump at higher rated and thus increasing the
heart rate and blood pressure and thereby increasing the risk factors of heart failure. Russell
also had previous pre-disposition of hyper-tension as indicated by the medication history if
anti-hypertensive drug (Atenolol). Fatima, Naqvi and Hanook (2019) further argued that
presence of COPD increase the tendency of heart failure due to the formation of pulmonary

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oedema. In this case, the chest X-ray of Russell revealed that cardiophrenic and costophrenic
angles indicating suggestive of pulmonary oedema. This again increases the risk factors of
heart failure. The Echocardio-gram indicated dilated left ventricle along with dysfunction in
the systolic side of the heart with left ventricular ejection fraction (LVEF) is 25%., indicating
the chances of left-sided heart failure.
Pathophysiology of left and right sided heart’s failure
There are two types of heart failure, left and right sided heart failure. The left sided
heart failure is again divided into two categories. First one is diastolic heart failure occurring
due to preserved ejection fraction and the second one is systolic heart failure occurring due to
reduced ejection fraction. Russell is suffering from left sided systolic heart failure because his
echo-cardiogram indicated reduced left ventricular ejection fraction. The right sided-heart
failure occurs as a result of occurrence of the left sided heart failure (Bosch et al., 2017).
After the failure of the left sided heart, the overall fluid pressure is transferred to the lungs.
This leads to the damage of the arteries and veins present at the right side of the heart. The
damage of the right sided ventricle and arteries ultimately leads to the back flow of the blood
into the veins and ultimately resulting in the development of the right sided heart failure. In
case of the right sided heart failure, the main symptoms that are pronounced included
swelling of the peripheral regions of the body like the foot ankle along with swelling of the
gastro-intestinal tract of liver (Bosch et al., 2017).
The detection of the left sided heart failure can be done with the help of echo-cardio-
gram as in case of Russell. In case of right-sided heart failure, the detection can be done with
the both echo-cardiogram and by conducting the chest X-ray. The result of the chest X-ray
will indicate the presence of pulmonary congestion (Bosch et al., 2017).

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Figure: Right, Left and Congestive Heart Failure
(Source: American Heart Association, 2019)
Acute exacerbation of COPD’
Exacerbation means negative feeling or making the situation worse. Exacerbation in
COPD indicates increase in severity of the disease. Exacerbation of COPD occurs during the
amplified response towards the secretion of the mucous in the pulmonary airways (Craft &
Gordon, 2019). Hyper secretion of mucus leads to the development of chronic bronchitis
along with destruction of the tissues of the pulmonary lining (emphysema). This further leads
to the subsequent disruption of the optimal defence mechanism of the pulmonary arteries and
thus resulting in the formation of inflammation in the small airways and fibrosis (Ko et al.,
2016). The overall pathological changes in the airway further increase the infiltration of the
phagocytic cells in the pulmonary cavities like marcophages, mast cells, neutrophills and
eosinophills. The degranulation of the mast cells and other phagocytic cells cause deposition